Mammographic and Sonographic Features of Breast Cancer in Women Before 30 Years of Age

Background: Breast cancer uncommonly occurs in young women, but, tends to be diagnosed at a later stage and have a poorer prognosis than in older women. Standard screening guidelines for this age group are not established and the radiologic features of breast cancer in young women are not fully studied yet, because of the low incidence. Objectives: To investigate the imaging findings for breast cancer in women aged 30 years or younger and to correlate them with clinicopathologic features and immunohistochemical subtypes. Methods: The study included 52 women with surgically confirmed breast cancer. The medical records of the patients were retrospectively reviewed and the mammographic and ultrasonographic findings were evaluated according to the fifth edition of the ACR BI-RADS lexicon. Results: Most of the tumors in this study were presented as a self-detected mass (42/52, 80.8%) and were of histologic grade III (31/43 invasive carcinoma, 72.1%) and the estrogen receptorpositive subtype (32/52, 61.5%). The most common mammographic finding was an irregular (19/24, 79.2%), indistinct (16/24, 66.7%), and hyperdense (20/24, 83.3%) mass. The ultrasonographic findings were of an irregular (32/47, 68.1%), indistinct (19/47, 40.4%), and hypoechoic/ heterogeneous (40/47, 85.1%) mass with no posterior features (34/47, 72.3%). An oval/round-shaped mass on ultrasonography was also correlated with triple-negative cancer (p=0.011). Conclusion: On mammography and ultrasonography, breast cancer in young women usually presents as a mass with irregular shape and indistinct margin. Some radiologic findings could be used to predict the molecular phenotype of the tumor.

Radiological review of prior screening mammograms of screen-detected breast cancer

Objective To perform a radiological review of mammograms from prior screening and diagnosis of screen-detected breast cancer in BreastScreen Norway, a population-based screening program. Methods We performed a consensus-based informed review of mammograms from prior screening and diagnosis for screen-detected breast cancers. Mammographic density and findings on screening and diagnostic mammograms were classified according to the Breast Imaging-Reporting and Data System®. Cases were classified based on visible findings on prior screening mammograms as true (no findings), missed (obvious findings), minimal signs (minor/non-specific findings), or occult (no findings at diagnosis). Histopathologic tumor characteristics were extracted from the Cancer Registry of Norway. The Bonferroni correction was used to adjust for multiple testing; p < 0.001 was considered statistically significant. Results The study included mammograms for 1225 women with screen-detected breast cancer. Mean age was 62 years ± 5 (SD); 46% (567/1225) were classified as true, 22% (266/1225) as missed, and 32% (392/1225) as minimal signs. No difference in mammographic density was observed between the classification categories. At diagnosis, 59% (336/567) of true and 70% (185/266) of missed cancers were classified as masses (p = 0.004). The percentage of histological grade 3 cancers was higher for true (30% (138/469)) than for missed (14% (33/234)) cancers (p < 0.001). Estrogen receptor positivity was observed in 86% (387/469) of true and 95% (215/234) of missed (p < 0.001) cancers. Conclusions We classified 22% of the screen-detected cancers as missed based on a review of prior screening mammograms with diagnostic images available. One main goal of the study was quality improvement of radiologists’ performance and the program. Visible findings on prior screening mammograms were not necessarily indicative of screening failure. Key Points • After a consensus-based informed review, 46% of screen-detected breast cancers were classified as true, 22% as missed, and 32% as minimal signs. • Less favorable prognostic and predictive tumor characteristics were observed in true screen-detected breast cancer compared with missed. • The most frequent mammographic finding for all classification categories at the time of diagnosis was mass, while the most frequent mammographic finding on prior screening mammograms was a mass for missed cancers and asymmetry for minimal signs.

Histopathology findings of non-mass cancers on breast ultrasound

Background There is little research done on non-mass cancers (NMCs) on breast ultrasound (US). Purpose To evaluate large-sectional histopathology findings of NMCs on breast US. Material and Methods The mammographic and histopathology features of biopsy proven 36 breast cancers which showed pure non-mass lesions on US were retrospectively reviewed. Results The most common mammographic finding was microcalcification (23/35, 65.7%); fine pleomorphic microcalcification was predominant (18/23, 78.3%). The main tumor type was pure ductal carcinoma in situ (DCIS) (14/36, 38.9%) and DCIS with micro- or minimal invasion (11/36, 30.6%). Among the 25 DCIS, histologic grade was high in 15 (60.0%) and intermediate in nine (36%); comedo necrosis was seen in 17 (68%). Immunohistochemical analysis was available in 27 lesions and showed HER2-overexpression in 12 (44.4%) and triple-negative in two (7.4%). Conclusion According to our limited patient sample, NMCs on breast US were mainly associated with high-grade DCIS.

Architectural Distortion (Cancer)

An architectural distortion (AD) is an alteration of the breast parenchyma, which results in radiating lines or spicules emanating from a point without a distinct mass. It can occur as the primary finding, or it may be an associated feature of a mass, asymmetry, or calcifications. AD is a mammographic finding with a high positive predictive value for malignancy and is a major cause of false-negative screening exams. This chapter, appearing in the section on asymmetry, mass, and distortion, reviews the key imaging and clinical features, imaging protocols, differential diagnoses, management recommendations, and potential pitfalls for a malignant architectural distortion. Topics discussed include superimposition of breast tissue, localization, workup of tomosynthesis-detected architectural distortion, and image-guided biopsy options.

Stereotactic Core Biopsy

Stereotactic biopsy systems utilize angled mammography images and parallax shift to localize and sample a target. The most common indication for stereotactic core biopsy is to sample suspicious/indeterminate calcifications, but it can be used to biopsy any mammographic finding (mass, developing asymmetry, architectural distortion). In benign cases, core biopsy may avoid unnecessary surgery. In malignant cases, core biopsy allows for a pathological diagnosis prior to lumpectomy, and better surgical planning. This chapter, appearing in the section on interventions and surgical procedures, provides a practical guide to stereotactic core biopsy. Topics discussed include stereotactic core biopsy equipment, procedure protocols and pitfalls, clinical management, and imaging follow-up.

Oil cyst of breast: a rare mammographic finding

Oil cysts of breast are rare benign breast disorders resulting from fat necrosis. Oil cysts are rare mammographic findings encountered. Here, we describe a case of 35 years female with history of breast trauma who presented with a small breast lump which was later diagnosed as oil cyst.

Comparison of handheld ultrasound and automated breast ultrasound in women recalled after mammography screening

Background Automated breast volume scanner (ABVS) is an ultrasound (US) device with a wide scanner that sweeps over a large area of the breast and the acquired transverse images are sent to a workstation for reconstruction and review. Whether ABVS is as reliable as handheld US is, however, still not established. Purpose To compare the sensitivity and specificity of ABVS to handheld breast US for detection of breast cancer, in the situation of recall after mammography screening. Material and Methods A total of 113 women, five with bilateral suspicious findings, undergoing handheld breast US due to a suspicious mammographic finding in screening, underwent additional ABVS. The methods were assessed for each breast and each detected lesion separately and classified into two categories: breasts with mammographic suspicion of malignancy and breasts with a negative mammogram. Results Twenty-six cancers were found in 25 women. In the category of breasts with a suspicious mammographic finding (n = 118), the sensitivity of both handheld US and ABVS was 88% (22/25). The specificity of handheld US was 93.5% (87/93) and ABVS was 89.2% (83/93). In the category of breasts with a negative mammography (n = 103), the sensitivity of handheld US and ABVS was 100% (1/1). The specificity of handheld US was 100% (102/102) and ABVS was 94.1% (96/102). Conclusion ABVS can potentially replace handheld US in the investigation of women recalled from mammography screening due to a suspicious finding. Due to the small size of our study population, further investigation with larger study populations is necessary before the implementation of such practice.

Analysis of Shape-Based and Texture-Based Attributes in Classification of Mammographic Findings by Machine Learning Algorithms

Breast cancer is the most frequent cancer type among women. We present a method of classification of nodules (malignant or benign) found in mammograms using shape-based attributes and texture-based ones. Firstly, we built a test database, then we segmented and extracted a Gray Level Cooccurrence Matrix (GLCM) from each mammographic finding and analyzed texture-based and shape-based attributes. Finally, classification was performed through machine learning algorithms. Tests reached a maximum Correct Classification Rate (CCR) of 93.75%, when performed with the Radial Basis Function Network algorithm. The largest area under the ROC curve (AUC), 0.964, was achieved with the Multilayer Perceptron algorithm.